Page 353 - Withrow and MacEwen's Small Animal Clinical Oncology, 6th Edition

CHAPTER 17 Integrative Oncology 331

See the Big Picture often define the trajectory of acupuncture channels. A cascade of
responses follows in the central nervous system (CNS) and auto-
nomic nervous system (ANS), generating somatosomatic, somato-
By definition, integrative oncology includes both conventional
VetBooks.ir and complementary medical treatment methods; this may autonomic, and somatovisceral reflexes in spinal cord segments
translate into multiple health care providers participating in the
related to the excited nerve(s). In addition to propriospinal signal-
patient’s treatment care. Communication becomes vital to avoid ing, acupuncture induces changes in the neuronal firing patterns
unnecessary, duplicative, or counterproductive approaches. Some- in the limbic system, cerebellum, cortex, and brainstem. Func-
times, excessive treatment can be taxing on both the patient and tional brain imaging research shows, by reflecting alterations in
client, and a frank discussion about what is working and what is neuronal metabolism, which centers process pain, regulate auto-
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not may streamline care and place fewer burdens on both. Explor- nomic function, and affect moods in response to acupuncture.
ing the pros and cons in this broader context with the client may This aids in the ever-deepening awareness of the neurophysiologic
help alleviate family members’ feelings of guilt and the fear of “not underpinnings of acupuncture.
doing enough,” when in reality they might be doing more than
indicated or warranted. How Might Acupuncture Benefit a Veterinary Patient with
Cancer?
Recognize Patient Comorbidities Although acupuncture provides repeatable and measurable ben-
efits for patients with advanced cancer, the treatment is under-
The advanced age of patients with cancer raises the likelihood that utilized. 16–22 Human integrative oncology clinics have found
those individuals will be harboring medical and/or physical prob- acupuncture to be a safe, inexpensive, and effective intervention
lems in addition to neoplasia. Attending to the “whole patient” for problems that cancer patients often encounter, including leu-
embodies a cornerstone of integrative oncology care. Introducing kopenia, gastrointestinal upset, and systemic reactions. 23,24 Acu-
acupuncture and massage to alleviate pain and stress carries the puncture may reduce the emetic effects of chemotherapy and
side benefit of homeostatic regulation and stronger host defenses opioids. 25,26 For pain management, many studies on acupuncture
(i.e., robust immunologic protection and the ability to recover show improvement, though more rigorous studies are needed.
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after injury). Evidence suggests that patients who feel better over- Acupuncture has also been used to treat fatigue, hot flashes,
all will more likely complete their planned course of chemother- immune system support, neuropathy, anxiety, depression, xero-
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apy and/or RT and have more positive results. 4,5 stomia, 28-30 and sleep disturbances in humans. Even for human
Fully evaluating a patient with myofascial palpation before patients with advanced, incurable cancer, acupuncture has been
6
chemotherapy and/or RT with respect to general well-being shown to alleviate a wide range of symptoms with no significant
may provide practitioners insight into ways to address preexist- or unexpected adverse effects.
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ing pain and dysfunction even before conventional treatment
commences. Risks of Acupuncture
Studies indicate that acupuncture performed by a medical pro-
fessional for patients with cancer poses little risk of injury. 33–35
Common Approaches in Integrative That said, one should obviously avoid penetrating the tumor or
Oncology seeding local tissues with cancer cells. Owing to the complexity
of treatment and patient considerations for animals with cancer,
Acupuncture any acupuncturist treating animals should have a thorough under-
standing of animal health and disease, and acupuncture anatomy
Nearly two-thirds of human cancer patients experience pain. and physiology, to minimize risk of injury.
7,8
Negative side effects from opioid analgesics or other concerns
regarding conventional pain medications often prompt clients to Botanical Medicine
request drug-free alternatives. Acupuncture, which uses the inser-
tion of thin, sterile needles into certain sites (called “acupuncture Considering their diverse and documented anticancer benefits,
points”) on the body is one such alternative. plant-based medicines offer some of the greatest hope for an
Acupuncture points correspond to influential neurovascular or actual cure for cancer. After all, nearly half of cancer drugs used
myofascial zones that, when activated, promote analgesia, recovery over the past two decades arose directly as derivatives from plants
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of normal circulation and immune function, physiologic restora- or indirectly, as chemically altered derivatives. Classes of plant-
tion, and homeostasis. 9,10 In addition to needling, other forms of associated chemotherapeutics include the vinca alkaloids (vin-
somatic afferent stimulation include acupressure, laser acupunc- blastine, vincristine, and vindesine), the taxanes (paclitaxel and
ture, and electroacupuncture, wherein one clips electrode wires to docetaxel), camptothecin derivatives (irinotecan and camptoth-
the needles to augment the stimulation and neurologic response. ecin), and the epipodophyllotoxins (etoposide and teniposide).
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Research supports that patients who receive acupuncture require The search for new and better drugs continues; to date, the NCI
less medication to control pain. 11,12 has screened tens of thousands of plant species for anticancer
Specifically, nerve fiber stimulation begins at the needle–tissue value. Of these, nearly 9% have demonstrated reproducible
interface, where local alterations in cytokines and inflammatory activity against cancer. 37
mediators lead to modulation (i.e., normalization) of circulation Many natural products from both Eastern (most notably,
and immune function in the immediate area surrounding the site Asian) and Western herbs have demonstrated anticancer ben-
around the needle. 13,14 From there, agitation of the connective efits through in vitro analysis of their effects on human cancer
tissue and subsequent tugging of the collagen fibers, fibroblasts, cell lines. For example, extracts and pure compounds derived
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and myofascia in the region produce activation of sensory somatic from the Chinese herb Euphorbia fischeriana Steud exhibit anti-
and autonomic nerve fibers. When excited, afferent pathways tumor, antimicrobial, antiviral, immune stimulating, and analge-
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ferry action potentials along large nerve axons that underlie and sic activities. Research on mice has shown E. fischeriana extracts